Hopsital Combat II

The piece which am referring to is a well prepared article by a good author( we all took Mrs. Obiwulu’s English lessons together) and a long time friend. The piece contains a lot of truth which I must say, as a medical doctor by profession, hit the point. But I must beg to differ in some of his opinions because there are obviously two sides to this story, just like a coin.

To start with, I want to make a bold point that we all (I mean doctors, medical laboratory scientists and nurses) all work for a common goal and that is “To care for the sick”.
This “motto” is what should be borne in mind whether you have an MBBS or a Bsc in Medical Laboratory Science or a Diploma or Bsc in Nursing Science.
Everyone knows their role. I must say so because none of these three departments cannot work without the other. As the common Igbo saying goes, “I gaghi aku aku na-agba agba” ,so it is in this situation.

But then I must point out that in every institution, there MUST be a leader otherwise the system will go into anarchy and everything will just be a mere charade. And that leader in this context is the Doctor. It is a well known and incontrovertible fact which is why the Chief Medical Director of any hospital is a doctor. At this point, I must dare to say that most doctors are egotistical, perhaps this is mostly due to the fact that most doctors bearing in mind that “the doctor is the head of the medical team”, take it too far by imposing there authority on others. This, I must say is VERY wrong as it undermines the common goal of the medical team as I have stated above.

Again, I would want to correct the author that it is the Doctors that makes a diagnosis and go further to proffer solutions to the problem. I must make reference to the medical curriculum (3rd MBBS to be more precise), doctors do a full and complete course in pathology which we know is the backbone of all laboratory courses done by the Medical Laboratory Science students. In essence, we are trained to use that knowledge and our clinical skills to come up with a diagnosis. At this point, I must say that the MLScientists still go a lot further to study the technical details in coming up with laboratory results which contribute to the eventual diagnosis. So I think it’s pretty explanatory why a Consultant Pathologist who is a doctor must control the laboratory departments. He is not just a newbie doctor who has passed all his MBBS exams but has gone ahead to obtain a 4 year Fellowship in a specific aspect of pathology.

As I said before, all these don’t matter at all if (and actually if) we have in mind that we are working for the common goal of the patient. Sadly, it is only in Nigeria we have all these problems. Abroad, everyone knows there role and they play it well knowing fully well their target.

In conclusion, I would also, like the author of the original piece and my very good friend, reiterate the Emmy Award winning Peter Dinklage in “The Game of Thrones” as Tyrion ‘the imp’ Lannister:
“Never forget who you are. The rest of the world will not. Wear it like armor and it can never be used against you.”

Thank you.
Alex Onyemeh (MD)

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54 Replies to “Hopsital Combat II”

  1. Let make some corrections to that wonderful reply.
    Medical laboratory science isn’t about technical work but medical laboratory technology is, which is now defunct and obsolete. I wasn’t in a medical school for 5years to learn just how to culture stool and urine samples, it goes deeper than that. I was taught how to correlate the lab findings with diseases and come up with a conclusion.
    I guess watching a lot of episodes/seasons of the series, Dr House has made my friend to believe they are the ones that actually diagnose the patients and not the scientist. I have just one question for you: why didn’t a doctor help in the discovery and diagnosis of SARS.
    Consultant pathologists impose themselves on the lab scientist but can any of them view the microscope properly and come up with definitive findings/conclusions?

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  2. Point of correction,it’s scientific work.laboratory diagnosis to be precise.Also,House read diagnostic medicine.he is nt just an ordinary doc and u cant compare dia and here.Chase,Foreman n Cameron ve dia own field, if u really understood House and they also know their barrier.they do d tests theirselves.Can u do any lab test apart from PCV?I dont fink so.
    doctors give differential diagnosis.if u do d diagnosis directly,y send dem to d lab
    Also,anybody can be a CMD.their is no law which says its only doctors dt can be CMD.Afterall na politics,If u ve a diploma in Admin or even MBA and u re a medical personeel.which kind leader be dt.u spent 5yrs 6 months and we spent 5yrs and u want to leda who.I refused to be led by nobody.Watch out! Medical laboratory scientist re growing rapidly.we”ll definitely be dia in less dan 10yrs.

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  3. Thanks to the comments. To start with Arinze, it’s true that we can’t equate our 3rd MBBS course to ur total course work of 5yrs. Good and fine but I must point out that the reason why we take those courses is to interprete the lab results and to correlate it with clinical findings thereby coming up with a definitive diagnosis. Yes you werent in med school to just culture urine and stool but you should know more of the laboratory part of medicine than anybody, even the doctor with just an MBBS (because thats your major!) but then I will tell u that I spent 6 yrs in school to learn how to relate lab values with disease processes( and that’s my major, lab stuff is my minor) and it still doesn’t mean that if a consultant looks through a microscope, he can’t make conclusions, he can make a lot of meaning more than the lab scientist cos he is the best of both worlds (if he can’t, then he CANNOT be a consultant)
    I must also point out that the differential diagnosis is done based on history and clinical examination ONLY and not after tests and investigations. It’s this history and clinical examination that will guide the clinician to order for some SPECIFIC tests and then the patient is sent to the lab. What I want to say is that the doctor already has a couple of diagnoses in mind before actually sending the patient to the lab. So you CANNOT tell me that the med lab scientist does the diagnosis. Moreover here in UNTH where I work(and I believe in other hospitals), there is a column for “provisional diagnosis ” on the lab request form (check it out if you don’t believe me!). So essentially the med lab scientist is already informed before even starting the test. So any diagnosis isn’t even his to make.
    As for CMD, as far as we are here in Nigeria, it’s only a medical doctor that can be the CMD in a govt owned institution. Even an okpa seller who has made money can be the CMD of his own hospital and employ professors and consultants to consult!! But as far as we are talking about govt institutions, it’s only a medical doctor, the head of a medical team, that can lead either as CMD or Commisioner of health or Minister of health.

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    1. Lol, I didn’t want to comment but you asked for it. First of all, a consultant pathologist “must not” be a doctor, I can be a consultant haematologist etc if I wish to be, have you ever thought about that? Our mentality in Nigeria is so “narrow”.
      A consultant pathologist (doctor) knows more than a consultant lab scientist? I laff in greek. I don’t blame you, I blame my senior colleagues who have failed to further their education. I’m glad you realised the lab field is your minor. A doctor doesn’t know shit about the microscope, its findings and correlation with disease processes more than a well informed lab scientist. With my experience, I’m certain what u see in text books is totally and entirely different from what you see when u view the microscope.
      Yes, there’s a space for provisional diagnosis on a lab request form but if I provide u with results that contradict your so called provisional diagnosis, you will be confused mate. You send in a patient for urea and creatinine tests, if these two values don’t correlate, you will be as confused as our president.
      You claim to be the diagnostic tool, why do u send patients to lab then? Since you can clerk the patient and get info about the disease. Please stop deceiving yourself. Why then are microbiologists et al behind the discovery of all these emerging infectious diseases? Why not doctors? Have you ever given serious thought to that?
      And you just depicted to everyone reading this, you guys are just a bunch of conceited and egocentric jerks who think they know it all.
      As per the case of CMD, I don’t even care about who heads the hospital.

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  4. Why the war in d fierst place? Everybody face your front and lets have peace in the medical field pls . Doctors should face their field in our hospitals pls. but why are doctors not compeating with another field in the medical, why only lab scientist? I think there is something special about Us

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    1. I must correct you my learned colleague, the doctors are after every field. They have usurped the radiologist, radiographers, epidemiologist and the lab scientists. My application for a masters in oncology was rejected, that I must have an MBBS but a doctor can apply for a masters degree in every medical field. Ain’t that funny?

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      1. Zinga, although I am also a lab scientist but I fink dia r sm atom of truth in wat uя̲̅ frend alex said. Cos in the US lab scientists are not consultants but there is no conflict btw the lab scientists απϑ the consultant pathologists dey all coexist happily n dia duties are well defined. Those doctors actually undergo intense training durin dia residency n I fink we also need smtin lyk dat in our own field.

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      2. My dear ada, am not beefing anybody, if you read my first note, I concluded by saying we all need each other. But if u must know, google IBMS and find out if lab scientist diagnose or not and if they can be consultants or not.

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  5. WITHOUT PREJUDICE… I consider this a watering down of standard joining this dumb arguement. But to the author of this crap… Clearly u r absent proper information n u are grossly deranged if u think ur work as a lab scientist is to make diagnosis. Thank ur stars that litigations in Nigeria is poor… If u want to becom a consultant pathologist go get an MBBS otherwise be content with ur job or quit. Health is a delicate issues n quackery is not tolerated in places that have functional laws.

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    1. Loool, I had to read your comment over and over again and laugh at your stupidity. Chale, if there’s anybody who is misinformed here tis you. According to Institute of Biomedical Scientists (IBMS), the substitute Medical Lab science body in UK, the role of a biomedical scientist is to diagnose disease and evaluate the effectiveness of judgement through the analysis of fluid/tissue samples from patients. I guess that’s simple english and u can comprehend that easily. They also made it clear that a biomedical scientist can be a consultant in his field and a doctor doesn’t have to head his niche when he’s there.
      So bro, before u spit fire, be informed!

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  6. i’ll start by saying, the bedrock of modern medicine is medical laboratory science. I think the doctors are more concerned with politics than their patients or further studies. the brain drain of being the most important person in the hospital starts from med school. Abroad it aint so. Even the cleaner is not just necessary but important to avoid infection and quick recovery of patients. A doctor friend once told me that the doctors in our country are jack of all trade, master of none. i think we can all help our patients more by learning to co exisr with one another instead of the continous bickering about who is more superior. I urge this young generation of medical professionals to not be caught up in this unproductive nor progressive tug of war. By the way when two elephants fight, the grasses suffer

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  7. Zinga or woteva,dis is simply d job of a jobless fool. Don’t picK fights wer u can’t even cause a scratch. Dis is simple. Just go back,write jamb n series of medical exams n den come out and make an arguement. It s dat simple. Or beta still,come n diagnose ventricular septa defect and carry out management. Stop beefing bro. If u can’t beat dem, just join dem. Get dat into ur seemingly light brain.

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    1. Lol, u called me a jobless fool. Well, I aint beefing no one and I made it clear that all medical professionals need each other for things to go right in a hospital.
      Don’t make me tell u what will make u regret ever commenting on this page.

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  8. To those who are apparently reading this that aren’t in the medical field, everybody (nurses, doctors, pharmacists, lab scoentist, radiographers etc) plays an important role in ensuring you are treated and well cared for.
    I must also add that according to UK University & Colleges Admissions Services (UCAS): “when you go to the doctor, you can be sure the work of a biomedical scientist is behind the diagnosis and cure for the condition bothering you.”

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  9. Hey,dat was harsh bro.but I understand ur frustration. Mr zinga I dispute d fact dat u said u mk diagnosis. N I guess u r partially informed ursef. For a diagnosis 2 b made it starts wit the dr getting to knw the patient well. A detaied history must b made,examination carried out physically on d pt b4 d investigations n dats wer u come in. I believe u r well learned n knw theortically how to read samples 2 suggest a diagnosis,not make.u shuld get dat right,and check well most lab results always bear a working diagnosis made by d dr.n u might not even come in contact wit d patient. That apart,doctors are not trying to tak over anything, all d subspecialties are tot 2 docs in trainin,dats why dey can decide 2 specialise in pathology,radiology,medical therapeutics and so on.u ve gat 2b broad minded.we need you guys 2 achieve an aim,but we stil are and will remain the head of the medical team. Can u ans just a small question. How much radiology,therapeutics,surgery,medicine n so on did u do as an undergraduate?

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    1. I must say you are reasonable but endeavour to read my first note, I stated that we all need each other. As per diagnosis, What’s diagnosis sef? You need to answer that. I guess u’ve seen IBMS definition of the role of a scientist. The doctor/lab scientist are involved in diagnosis. I never said it’s the sole responsibility of the lab scientist. As per therapeutics, radiology, surgery, I did none of them buh I didn’t management and economics courses and you didn’t yet you are the one at the helm of the hospital. I’m not after that either.
      One hospital, one body, one goal…to heal the sick!

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  10. @ Arinze,seen all you said but now I have to tell you that you are far out of line bro. U took my last comment too far, I must confess. I will close my end of the curtain by telling you that since you “make” diagnosis, you can go ahead and open a private hospital where you can start consulting. Am sure it’s gonna be awesome! And then I suggest that you leave IBMS to the UK ppl, maybe wen u go there, u can start diagnosing them( Diagnoser!). Have fun. I will be following the comments.

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    1. I took your comment too far cos you deviated from my point (for my colleagues to further their education) and I thank you for bringing your unec graduates to my blog. It’s very easy to pick them out from a crowd of people. As per diagnosis, I believe you can read well so read my comments properly. And as the diagnoser you are, when you open a hospital, don’t have provision for a laboratory department aigh.

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  11. Wats ur problem? U did nt meet the minimum requirement for takin a course in oncology… Go get it naa…u r here writing bullcrap dat will nt change anyfin…waisting precious tym. C u, u wan handle human lives wifout adequate qualificatn… Hmmm, Naija z improvin o! Soon quackery go fizzle out entirely by d tym lawyers begin specialize well for medicolegals… In case u dey plan bcom doctor wifout MBBS… No go cari wahala for ursef o!

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      1. Ahn ahn! Bro hit d ball not d player… K? U claim to make diagnosis, ok… How much of the pathological basis of diseases do u know? Grossly, let alone at d molecular level… Zap!

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  12. Now u come.I agree dat we need u guys.u r very vital.but it still doesn’t rule out d fact dat d dr is d head of d medic team anywer anytym. As for management issues d head of a hospital is n wil eva remain d medical director,and as d head,wat do u tink? Its different if u own a big hospital n employ a doc,but he/she wil stil head d medical decisions. By d way evn most dev countries biz men open hospitals build up committee of directors,but still medical docs are made the chief medical director.

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  13. Now u come.I agree dat we need u guys.u r very vital.but it still doesn’t rule out d fact dat d dr is d head of d medic team anywer anytym. As for management issues d head of a hospital is n wil eva remain d medical director,and as d head,wat do u tink? Its different if u own a big hospital n employ a doc,but he/she wil stil head d medical decisions. By d way evn most dev countries biz men open hospitals build up committee of directors,but still medical docs are made the chief medical director. Without it,der wil be enuf litigations

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    1. My brother, I still say this, I’m not fighting with doctors but only imploring and encouraging my collegaues to go back and add qualifications to their resume. I believe you are far more reasonable than most people here.

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  14. Yeah thanks Aribobo, u re quite right, it’s easy to pick out UNEC graduates from a crowd (*wink wink*). I think if one follows the threads from the beginning, it’s quite obvious who took the first step in going far. But then am happy with your last threads as you came to reiterate that fact that we have one goal and that is to care for the sick as I clearly stated in my post. We all have to work in our different capacities to achieve this goal. Thanks

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  15. Woow. This is amazing. Really amazing. Ok, now my comment is this. There is no one in charge of diagnosis. There are steps taking in making a complete diagnosis which involves the doc and the lab scientist, the radiologist too. The provisional diagnosis made by the doc are the reasons for the specific tests he requested for. The results of the scientist will either confirm or dispute it. No one is more impt than the other. Doc pathologist are there to interpret and explain the results to their fellow doc. (Not to head the lab). And pls a pathologist must not be a doc. A lab scientist can be one too. I’m already in the course. The hospital must be headed by a doc? Where did u get that from? Thats just in nigeria. Its not even in the constitution. Its just politics. Once u attain the position of a director in ur field, U qualify to apply for the position of CMD. I will conclude by saying this, until docs stop playing lord and master over other med dept. the health sector of this country will only get worse. Forget who is in charge and do ur jobs.

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  16. Good Gloria!!! Anybody can be a pathologist… For a scientist, u take an MSc n all dat, or have ur special PG school, as a means of acquiring more knowlege needed for the execution of ur duties yle a doctor can take a 6yr or so Residency programme at the Postgraduate Medical College to bcom a Fellow(Consultant) in pathology. Why then shd a doc be in the lab? Simple, cos d patient is the central figure not the specimen. Everywhr in the world, doctors r free to practice lab medicine. Let me put it this way…
    D nurses take charge of the wards n clinic, d scientist takes charge of the lab, yle d doctor take charge of the patient. So inasmuch as wat goes on in the lab, clinic n wards hv to do wif patients, dia will be a doctor dia. Concerning heading the health sector, a 1990 decree holds that the doctor is the head of the health sector (administratively) n dats d situation in Nigeria until it changes. A good number of doctors take courses in Health admin so as not to be found wanting in this responsibility imbued on em by the Government. It is going to be a sheer act of insubordination to the govt of our time to fight the leadership position of d doctor. Personally, I fink it shd be made open to all even those who studied management provided they are proven to be capable, but for now its not about my personal views.
    I wish to peacefully rest my case.
    Without Prejudice,
    Lexi B (MD).

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  17. Lol. You guys won’t kill me here. I swear. Its really funny how this never ending battle between doctors and lab.scientists/pharmacists, never ends.

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  18. I believe we are all youths,let just leave the politics dt our senior colleagues ve started in d Medical profession n face our sole responsibility which is d patient. But my little advice to doctors is for them to respect other people in d profession n nt to see odas as inferior beings.

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  19. In the end, this reply by my doctor friend deviated from the point I made in my first article and incited both his doctor colleagues and me, the lab scientist. If you do know me in person, you would agree with me that I don’t even contribute in the war between doctors/lab scientists, I see it as a waste of tym.The problem is easy and simple to eradicate, know your role and play it well but have it at the back of your mind that nobody knows it all and this is science, new findings evolve everyday. One of the doctors asked about molecular & pathological aspects of diseases, due to misinformation he belives he’s the only one who knows that, he is wrong but I don’t want to argue about that.
    My fellow scientists both young and old, go back to school, acquire more knowledge and add qualifications to your resume. Knowledge is power and when you have that power, nobody can shake you.
    One hospital. One body. One goal….to heal the sick.

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  20. health sector is multidisciplinary. Everybody should do his or her work and leave d administrators 2 do d administrative wrk. Here in Uk everybody is lord in his own unit. And ur paid based on ur specialty. A surgeon earns more than a radiologist and even d pathologist dat does interpretation of result. Even so mlsct earn more than dem. Tc(M.path)

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  21. i see Nigeria pathologist as i lazy Doctor who jus want 2 sit and head d lab. Without knowing its duty as in interpretation of d result 2 d clinicians. I think dey lack focus in Nigeria different frm wot we see here. Alot of us here are runing dis fellow in pathology very soon Royal colleage will certify me with FRCpath. Still me Tc(M.path)

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  22. My dear friends. Come to think of it… This whole arguement is funny. Who is more important in making diagnosis??? The doctor?? The medlab scientists??.. Well I guess both are….. Lemme even go further and say dat the lab result even help us in treating our patients… For example,, you have a patient with meningeal irritation and high fever with multiple generalised tonic clonic seizures, u knw its meningitis, but u still do a lumbar puncture and send the csf to d lab. U start treatment with penicillin. A few days later, d result comes out and u find out that indeed ur provisional diagnosis is correct, however the causative organism is not sensitive to ur penicillin like ur internal medicine consultant thought u it should. But anoda antibiotic?? Definitely u have to change medication for the good of ur patient and rest your doctor ego…………..the other side of the arguement is that we as doctors are thought to make PROVISIONAL DIAGNOSIS from history and physical exam. Moreso, we are thought to treat our patient and not the lab result. My dear, that you bring me a result with 4+ plasmodium does not mean that my patient with chronic cough, without fever atall has malaria as his main problem……..
    In conclusion, permit me to say that the most important aspect in medicare is not the doctor, or the scientist, but the pharmacist and their drug companies who manifacture drugs, no wonder the drug companies like emzor and pfizer are among the highest grossing companies in the world…… After making your diagnosis, what next??? Without the available drugs, ur patient is as good as death… U cannot perform a surgery without anaesthetics and antibiotic cover… The normal saline we routinely give to our admitted patients are all produced by the pharmaceuticals……

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  23. Hmm,am very much pleased wit Edoggy. When d writer was listing d medical team he didn’t make mention of d pxcist. As a pharmacist in training but witout biase… I must say all dis bickering is for notin if d patient doesn’t get better. As gloria said it doesn’t matter who is in charge. If u want to be in charge get d qualifications necessary. D purpose of d medecine profession wud be defeated witout drugs. Dat being said we all shld face our jobs squarely and strive to make d patient better

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  24. issues,issues,issues.
    This war is just getting started.
    And its not btw d doc/lab scientist but across d medical field.
    Its just so unneccessary.
    Everyone shud know his place.
    Order is impt.the older generation has let us down in many areas.this issue shud neva hav arisen in d 1st place.they shud sit down and hash out the medical circle of life.

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  25. Joblessness @ its peak!
    I guess very soon too,d cleaners wil start fightin 2 become heads too afteral dey also play an imp role in d hospital.
    I ve noticed dt most of d ppl dt engage in dis argument re dose dt wia denied admission in2 medicine so applied 4 oda medical courses. D main ppl dt ve alwaz wanted 2 bcom medlab Scientists know dia boundaries n jobs n do dem religiously. Dey ve litl tym 4 dis kinda blind argument nd baseless fight.
    Let’s face our diff specialties n stop lookin 4 hu’s head n hu’s not n why!!!

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    1. Wats all these trash abt doctors and med lab ? As if all doctors do is to send results to dem to make ‘definitive diagnosis’ .plz I hv several questions,do the lab results treat an hydroceph pxt?does it repair a vvfistula?does it treat a cephalopelvic disproportion?plz do ur work and let d docz do deirs to reach a common goal!!!good health for the pxt .but if U̶̲̥̅̊ don’t like ur job den…

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  26. U̶̲̥̅̊
    didn’t ve 2 call me a FOOL cos i told U̶̲̥̅̊
    d bitter truth. I was careful nt 2 use abusive words though som of ur comments deserved dt kinda reply buh i still didn’t.
    Now if U̶̲̥̅̊
    tnk ppl wil alwz agree wif wateva U̶̲̥̅̊
    put up on ur blog,U̶̲̥̅̊
    re mistakin. Ppl wil alwz disagree especially in dis kinda situation so U̶̲̥̅̊
    dnt ve 2 lose control of ur tongue n 2ro abusive words here n dia. Al U̶̲̥̅̊
    need do is iron out ur points if U̶̲̥̅̊
    ve any n den listen 2 d reasonin of odas.
    Nevertheless,whicheva way U̶̲̥̅̊
    guyz wanna look @ it,a DOCTOR is n will remain d head of d medical team(doesn’t mean he/she wil see odas as inferior or boss dem arnd),d earlier we al accept dat..d better 4 evrybody

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